MEDICARE: JUAN H FERNANDEZ MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61056	FL

General Provider Information

NPI Number	:	1679815518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN H FERNANDEZ MA

Provider Business Mailing Address
First Line	:	5809 SW 41ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5307
Country	:	US
Telephone Number	:	786-399-2788
Fax Number	:	786-464-0624

Provider Business Practice Location Address
First Line	:	5809 SW 41ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5307
Country	:	US
Telephone Number	:	786-399-2788
Fax Number	:	786-464-0624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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